Vejen til at blive bedre til at tackle smerter går gennem øget viden om smertemekanismen

Nervesmerter

 

Viden er nøglen

Af Lene Pilegaard

 

Ny forskning – ny viden

I løbet af de sidste 20 år er der kommet meget ny viden om hjernen, smerteneurologi, og vi ved nu, at der er en masse ting, man selv kan gøre for at få færre smerter – uden brug af medicin og uden bivirkninger. 

Det handler om at forstå og lære om smertemekanismen. At forstå, hvor mange ting der har medindflydelse på smerteoplevelsen, og som er medvirkende til smerteoplevelsen. At lære at kunne ændre nogle af disse ting er en del af vejen for at få et bedre liv med færre smerter. 

De fleste mennesker har en fejlagtig opfattelse af, hvad smerte er: At smerten opfanges i kroppen via smertenerver, der sender signalerne via særlige smertebaner til et særligt smertecenter i hjernen, og at den primære forståelse skal findes i vævet og kroppen.

 

Det er imidlertid en helt forkert opfattelse

Hele din krop indeholder millioner af sensorer, der konstant sender meddelelser/signaler til hjernen om situationen og tilstanden i kroppen og omgivelserne. Disse signaler er helt simple elektroniske signaler/impulser. Din krop har masser af disse sensorer spredt over det hele: Led, muskler, ligamenter, og huden, som også indgår i hele bindevævssystemet. Vores bindevæv er fyldt med sensorer og vores største organ. 

Disse mange sensorer sender konstant trillioner af signaler til hjernen. Nogle sensorer responderer på, om det er varmt eller koldt, andre responderer, når der er vævsskade, stræk eller tryk, og de trigger, at der sendes signal til hjernen, eller hvis der sker kemiske forandringer, fx ved mælkesyre eller inflammation i vævet.

 

Disse signaler er IKKE smertesignaler! Smerte er noget ganske andet.

 

Smerten laves af hjernen – 100 procent af tiden – uden undtagelser

Dette betyder, at der kan være faresignaler, endda mange, men at der stadig ikke føles nogen smerte. Du kan have en skade og stadig ingen smerte føle. Eksempelvis hos sportsfolk, der får en skade under en konkurrence, og som fortsætter og først bagefter finder ud af, at de har en voldsom skade.

Smerte er fantastisk

Det er et meget kraftfuldt og genialt beskyttelsessystem – så det endda kan forårsage, at der ingen smerte føles i nogle situationer.

Din hjerne laver smerten

Det er din hjerne, der laver smerten, når den konkluderer, at din krop er i fare, og at du skal agere og reagere for at undgå det, der er årsagen til smerten for derved at undgå yderligere skade og beskytte dig.

Smerten er et signal om at ændre adfærd – at du skal gøre noget – eller at du skal ophøre med at gøre noget. Det er et stort og kompliceret biologisk system, som endda kan forårsage, at der kan føles smerte fra en kropsdel, der ikke længere er der, som fx med fantomsmerter fra amputerede kropsdele.

Din krop kan altså ikke sende smertesignaler til hjernen – kun alarmsignaler og impulser. Smerte laves i hjernen.

En vigtig ting at forstå er konceptet og ideen med fare/alarm

Der er ingen smertenerver, ingen smertesensorer, ingen smertefibre i din krop. Der er sensorer, der kan opfatte og registrere forandringer i din krop og omgivelserne og sende alarmsignaler til din hjerne.

Hjernen ”lytter” til disse signaler, vurderer dem i sammenhæng med den nuværende situation/kontekst sammenholdt med tidligere erfaringer og vil enten lave smerte eller ikke.

Hvad er så kontekst?

Din kontekst kan være det sted, du befinder dig, din situation og nuværende omgivelser, sammen med dine overbevisninger, kulturel baggrund, sociale- og familiære situation, værdier, hukommelse, erfaringer, følelser etc. Alt i alt giver konteksten en unik mening i relation til dine tidligere erfaringer og følelser.

Grundlæggende vil din hjerne forårsage, at du føler smerter, når den konkluderer, at du er i fare.
 

Smerter er altid virkelige

Så længe du, din hjerne og nervesystem tror, der er fare på færde, vil du blive beskyttet i form af øget smerteoplevelse. Er du misinformeret om fareniveauet, vil du automatisk blive beskyttet, så aktiviteter og andre former for påvirkninger, der på ingen måde er farlige for dig, kan resultere i stærkere smerter eller smerte i det hele taget.

Dine helt unikke nøgler

Hvis du ønsker at formindske dine smerter og bedre være i stand til at tackle dem, har du brug for en strategi, der retter sig mod hjernen og ikke kun kroppen. For at formindske smerten er det nødvendigt at formindske sandsynligt bevis for fare og øge sandsynligt bevis for sikkerhed. Vi kan stimulere hjernens eget medicinskab og mekanismer.

Først og fremmest er det vigtigt, at du har en grundlæggende forståelse af smertemekanismen. Derefter at arbejde aktivt med tacklingsstrategier og at distrahere hjernen, så ”den glemmer alt om smerten”. Forskel­lige ”nøgler” kan åbne og lukke for medicinskabet i din hjerne. Det er forskelligt fra menneske til menneske, og du har dine helt egne nøgler, der kun virker for dig.

Udgangspunktet er, at mennesker, der lærer at forstå smerte, også bedre kan lære at leve med smerte med en reduceret smerteoplevelse og bedre er i stand til at tackle den.
 

Viden er nøglen

En af nøglerne er at forstå, hvorfor dine smerter ikke vil skade dig, men at din hjerne benytter smerte til at beskytte dig for enhver pris og til at informere dig om skade. Når du er klar over mekanismens hovedformål og virkemidler, vil du lettere være i stand til at arbejde aktivt og bevidst med at udvælge farereducerende aktiviteter og arbejde kognitivt med tanker og følelser. At få sat de ”gode neurotransmittere” i spil og minimere ”fareneurotransmittere” er en del af at få ”åbnet for hjernens eget medicinskab” via bevidst og kognitiv tankevirksomhed.

Sæt gang i hjernens eget medicinskab

Smerte påvirkes af en lang række forhold, som ikke kun har med den fysiske påvirkning at gøre. Smerte er en fantastisk beskyttelsesmekanisme, og hjernen er så sofistikeret, at den inddrager alt, hvad der kunne være potentielle trusler – måske også ”trusler”, der ikke er reelle.

Smerteoplevelsen påvirkes i den grad også af tanker og følelser, ting, som du tænker, tror og gør, og alt dette er med til at danne og aktivere neurotransmittere, som igangsætter en masse processer i din krop og hjerne. Neurotransmittere er fx dopamin, serotonin og gruppen af endorfiner, der er med til at dæmpe smerten.

Endo = Indre

Fine = Morfin


Du kan ved at blive bedre til at styre og kontrollere dine tankeprocesser, følelser og adfærd have en større indflydelse på din ”smertebremse” og din ”smertespeeder”.

Du vil føle smerte, når din hjerne konkluderer, at der er større sandsynligt bevis for, at din krop er i fare, end der er sandsynligt bevis for, at din krop er i sikkerhed.

Forskellige ”nøgler” kan åbne og lukke for medicinskabet i din hjerne, og da smerte er en helt personlig og subjektiv oplevelse, er de nøgler, der virker for andre, ikke nødvendigvis de samme, som gælder for dig. Det gælder om at blive bevidst om de helt unikke nøgler, der kun virker for dig.

Her er nogle eksempler på ”fare” og ”sikkerhed”, som kan have indflydelse på din hjernes vurdering. Disse eksempler repræsenterer et mønster af aktivitet i din hjerne – enhver tanke, handling, følelse har sit eget mønster – vi kalder disse mønstre for ”neurotags”.

Eksempler på ”sandsynligt bevis på fare”

  • At høre, at ”der ingenting er at se på en scanning, og der intet er i vejen med dig – så din smerte ikke er reel
  • At læse i avisen, at renten stiger
  • At tro på, at du ender i en kørestol
  • At vende tilbage til det sted, hvor du kom til skade
  • At få en diagnose, som lyder rigtig slem uden egentlig at vide, hvad det betyder

Alt, hvad der tilvejebringer et sandsynligt bevis for ”fare” eller ”sikkerhed”, har indflydelse på din smerteoplevelse.

Eksempler på ”sandsynligt bevis på sikkerhed”

  • At få at vide, at der findes videnskabeligt bevis for en behandlingsmetode, som med stor sandsynlighed kan hjælpe dig
  • At lave en aftale med en behandler, der højst sandsynligt kan hjælpe dig
  • At du ved, at du ikke er den eneste i denne situation
  • At have familie og venners støtte og support
  • At få smertestillende behandling, der virker – i hvert fald for en stund

Det kan være en god ide at definere dine egne ”sandsynlige beviser for fare eller sikkerhed”. At få dem beskrevet. Brug gerne post-it på en opslagstavle eller andet – hvor du deler dem op i ”fare” eller ”sikkerhed”. Du ved bedst, hvad der er dine situationer, der tilvejebringer følelser af ”fare” og ”sikkerhed”.

Det kan fx være:

  • Ting, du hører, ser, smager, lugter, rører ved
  • Ting, du gør
  • Ting, du siger
  • Ting, som du tænker og tror
  • Steder, du tager til
  • Mennesker i dit liv
  • Ting, der sker i og med din krop

Men husk, det er alt sammen i relation til kontekst.

Dine post-it-sedler vil blive din mulighed for at tænke over, hvad der sker – hvad der kan gøres, og post-it-sedler kan ende med at blive kasseret og nye komme til hen ad vejen. Men brug det som et redskab til at hjælpe med en bedre forståelse og tackling af, hvad der sker for din hjernes vurdering og dermed, hvornår den igangsætter, at du skal føle smerte.

Smerte er meget mere end blot en diagnose og resultatet af nogle tests – det er, hvordan du selv tackler den og agerer.

Kroniske smerteralarmsystem på overarbejde

Kroniske smerter kan ofte ikke alene tilskrives fysiske skader på kroppen, men stammer mange gange fra forandringer i vores nervesystems måde at fortolke disse signaler på. Med andre ord er nervesystemet øget følsomt og fastholdt i at beskytte et område, selvom en eventuel vævsskade er helet så godt som muligt. Dette kan medføre, at vores naturlige alarmsystem reagerer for ofte, for hårdt og uden nogen åbenlys årsag.

Jo længere tid dit nervesystem har beskyttet dig ved at sende ”faresignaler”, jo bedre er det blevet til at gøre det.

En anden måde at tænke over det på er, at nerverne, der formidler faresignaler til din hjerne, bliver mere sensitive og lettere kan aktiveres, og hjernecellerne, som er med til at danne ”neurotags” og neurale netværk, har også lettere ved at ”antænde”. Pludselig er du mere sensitiv over for signaler, som du ikke tidligere var – eksempelvis ved berøring, tryk, kulde og varme. Ting, der ikke gjorde ondt tidligere, gør pludselig ondt: at tage brusebad fx.

Det er ikke så svært – alle kan være med

Tanken om at skulle lære noget om smertefysiologi og smertevidenskab kan afskrække mange. Du har måske en opfattelse af, at det er alt for svært at forstå, og måske giver du op, inden du overhovedet har prøvet.

Prøv i stedet at betragte det som ny og vigtig information, som du skal bruge for at være i stand til at forstå og tackle din situation bedst muligt, øge din livskvalitet og få sænket dine smerter. Denne nye viden danner også grund for vigtige beslutninger, som du kan træffe nu eller i fremtiden, og derfor har du brug for denne nye viden om smertemekanismen.

Et vigtigt mål med at forstå smertefysiologien er at bruge det, der kaldes “dyb læring”, hvor information bevares og forstås og kan anvendes på aktuelle og kommende problemer. Kun ved at lære om, hvad man skal gøre, men ikke hvorfor, kan betragtes som “overfladisk” eller “overfladelæring”, og det giver ikke anledning til, at man kan opnå gode og varige ændringer i forhold til smertelindring og forbedring af livskvalitet. Det er først, når information både huskes og forstås, at det kan integreres med holdninger og overbevisninger.

At nå til en dyb læring er mere en proces end noget, man decideret skal kunne huske udenad. Så giv ikke op – vær tålmodig.

Forstå så meget som muligt, hvad der forårsager smerte, ikke kun, hvad du skal gøre ved det. Husk: Viden er den store befrier.

Du kender sikkert begrebet: No Pain, No Gain – måske man i stedet for skulle kalde det: Knowing Pain, or No Gain?

 

Kilde:                    

  • Moseley, L. and Butler, David: The Explain Pain Handbook, Protectometer, 2015, Noigroup                              
  • Moseley, L. and Butler, David: Explain Pain, 2003, Noigroup                              
  • Moseley, L. and Butler, David: Explain Pain Supercharged, 2017, Noigroup                              
  • Pilegaard, Lene, Smerte er fantastisk, 2019, Forlaget Dolores

Illustrationer: 

  • Lene Pilegaard

 

Læs mere:

I bogen Smerte er fantastisk får du forklaringerne bag smertemekanismen forklaret på en let og forståelig måde. Bogen er rigt illustreret, og alt forklares undervejs. Bogen indeholder desuden mere om smertesensibilisering, hvorfor hjernen skal inddrages, om placebo, og hvordan hele den eksistentielle del også er påvirket, herunder tab af identitet, livet med smerte og om sorg, skam, skyld. Bogen gennemgår desuden principperne bag kognitiv tankegang/terapi. Du kan læse meget mere om bogen her: www.smertererfantastisk.dk. Her findes også nogle af kapitlerne fra bogen som podcasts.

Bogen kan købes i alle danske boghandlere, direkte ved forlaget og lånes på biblioteket.  

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